Safety and efficacy of radiotherapy/chemoradiotherapy combined with immune checkpoint inhibitors for non-small cell lung cancer: A systematic review and meta-analysis

Frontiers in Immunology

Immunology

Fei Tang¹  Jing Wu¹  Yingbo Xue¹  Yan Li¹  Tingting Ni¹  Chunju Fang¹  Qi Zhang¹  Rong Deng¹  Qin Zhong¹  Yu Zhang²  Yan Zha³ 

[1] Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China;Department of Medical Oncology, Guizhou Province People’s Hospital, Guiyang, China;National Health Commission Key Laboratory of Pulmonary Immune-Related Diseases, Guizhou Province People's Hospital, Guiyang, Guizhou, China;Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China;

关键词: immune checkpoint inhibitors;    radiation therapy;    non-small cell lung cancer;    efficacy;    safety;    meta-analysis;   

DOI  :  10.3389/fimmu.2023.1065510

 received in 2022-10-09, accepted in 2023-02-27,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundIt is now widely accepted that radiotherapy (RT) can provoke a systemic immune response, which gives a strong rationale for the combination of RT and immune checkpoint inhibitors (ICIs). However, RT is a double-edged sword that not only enhances systemic antitumor immune response, but also promotes immunosuppression to some extent. Nevertheless, many aspects regarding the efficacy and safety of this combination therapy remain unknown. Therefore, a systematic review and meta-analysis was performed in order to assess the safety and efficacy of RT/chemoradiotherapy (CRT) and ICI combination therapy for non-small cell lung cancer (NSCLC) patients.MethodsPubMed and several other databases were searched (according to specific criteria) to find relevant studies published prior to the 28th of February 2022.Results3,652 articles were identified for screening and 25 trials containing 1,645 NSCLC patients were identified. For stage II-III NSCLC, the one- and two-year overall survival (OS) was 83.25% (95% confidence interval (CI): 79.42%-86.75%) and 66.16% (95% CI: 62.3%-69.92%), respectively. For stage IV NSCLC, the one- and two-year OS was 50% and 25%. In our study, the pooled rate of grade 3-5 adverse events (AEs) and grade 5 AEs was 30.18% (95% CI: 10.04%-50.33%, I2: 96.7%) and 2.03% (95% CI: 0.03%-4.04%, I2: 36.8%), respectively. Fatigue (50.97%), dyspnea (46.06%), dysphagia (10%-82.5%), leucopenia (47.6%), anaemia (5%-47.6%), cough (40.09%), esophagitis (38.51%), fever (32.5%-38.1%), neutropenia (12.5%-38.1%), alopecia (35%), nausea (30.51%) and pneumonitis (28.53%) were the most common adverse events for the combined treatment. The incidence of cardiotoxicity (0%-5.00%) was low, but it was associated with a high mortality rate (0%-2.56%). Furthermore, the incidence of pneumonitis was 28.53% (95% CI: 19.22%-38.88%, I2: 92.00%), grade ≥ 3 pneumonitis was 5.82% (95% CI: 3.75%-8.32%, I2: 57.90%) and grade 5 was 0%-4.76%.ConclusionThis study suggests that the addition of ICIs to RT/CRT for NSCLC patients may be both safe and feasible. We also summarize details of different RT combinations with ICIs to treat NSCLC. These findings may help guide the design of future trials, the testing of concurrent or sequential combinations for ICIs and RT/CRT could be particularly useful to guide the treatment of NSCLC patients.

【 授权许可】

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Copyright © 2023 Wu, Ni, Deng, Li, Zhong, Tang, Zhang, Fang, Xue, Zha and Zhang